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FAFSA logo: 2003-2004 Renewal
 
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Print a Copy of your Renewal FAFSA for your Records

Please print out a copy of your Renewal FAFSA for your records. It is important for you to print out a final copy of your information even if you have already printed out an application summary prior to this point as some of your information may have changed. To print select "Print a Copy For Your Records" button.

Print a Copy For Your Records

This is a COPY of your Renewal FAFSA for your records only. DO NOT mail this page to the Department of Education. We will not return it to you. Select the Next button at the bottom of this page to continue.

COPY OF YOUR 2003-2004 APPLICATION INFORMATION
DO NOT MAIL THIS DOCUMENT OR A COPY OF THIS DOCUMENT TO THE U.S. DEPARTMENT OF EDUCATION.
THIS IS YOUR COPY OF YOUR APPLICATION DATA.

 
Assumed fields, based on the data you entered, are marked with an '*' (asterisk) sign.
 
Student ID 559432934 HE
 
 
Step 1. (Q1 - Q35)
Last Name HEARTHSTONE
First Name, Middle Initial JAN O
Permanent Street Address P.O.B 746
City SEBASTOPOL
State Abbreviation, ZIP Code CA 95473
Social Security Number 559-43-2934
Date of Birth 03/22/1947
Permanent Home Phone Number 0000000000
Driver's License Number LOST
Driver's License State Abbreviation CA
Citizenship Status ELIGIBLE NONCITIZEN
Alien Registration Number 021552562
Marital Status SINGLE, DIVORCED, OR WIDOWED
Date of Marital Status 
Enrollment Status Summer Term 2003 FULL TIME/NOT SURE
Enrollment Status Fall Term 2003 3/4 TIME
Enrollment Status Winter Term 2003-2004 HALF TIME
Enrollment Status Spring Term 2004 3/4 TIME
Enrollment Status Summer Term 2004 HALF TIME
Father's Educational Level COLLEGE OR BEYOND
Mother's Educational Level COLLEGE OR BEYOND
State of Legal Residence Abbreviation HI
Legal Resident Before 1/1/98? YES
Date you became a legal resident 
Are you male? YES
Register you for Selective Service 
Type of Degree/Certificate GRADUATE/PROFESSIONAL DEGREE
Grade Level in College in 2003-2004 1ST YR.GRADUATE/PROFESSIONAL
High School Diploma or GED? NO
First Bachelor's Degree by 7/1/2003? YES
Interested in Student Loans? YES
Interested in Work-Study? YES
Convicted of Possessing/Selling Drugs? NO
 
Step 2. (Q36 - Q51)
Completed 2002 Income Tax Return WILL NOT FILE
Type of 2002 Tax Form Used 
Eligible to file a 1040A or 1040EZ? 
Student's Adjusted Gross Income from IRS Form 
Student's U.S. Income Tax Paid 
Student's Exemptions Claimed 0
Student's Income Earned from Work $0
Spouse's Income Earned from Work 
Student's Amount from Worksheet A $5000
Student's Amount from Worksheet B $0
Student's Amount from Worksheet C $0
Student's Net Worth of Current Investments $0
Student's Net Worth of Businesses/Investment Farms $0
Student's Cash, Savings, and Checking $0
How Many Months Receive VA Benefits? 0
Monthly VA Education Benefits Amount $0
 
Step 3. (Q52 - Q58)
Born before 1/1/80? YES
Working on Masters or Doctorate Program? YES
Are You Married? NO
Have Children You Support? NO
Have Dependents Other than Children or Spouse? NO
Orphan or Ward of the Court? NO
Veteran of U.S. Armed Forces? NO
 
Step 4. (Q59 - Q84)
Parent(s) Marital Status 
Parent(s) Marital Status Date 
Your Father's/Stepfather's Social Security Number 
Your Father's/Stepfather's Last Name 
Your Mother's/Stepmother's Social Security Number 
Your Mother's/Stepmother's Last Name 
Parent(s) Number of Family Members in 2003-2004 
Parent(s) Number in College in 2003-2004 
Parent(s) State Legal Residence 
Parent(s) Legal Resident Before 1/1/98? 
Date Parent(s) Became Legal Resident  
Age of Older Parent 
Parent(s) Filed 2002 Income Tax Return 
Type of 2002 Tax Form Used 
Eligible to file a 1040A or 1040EZ? 
Parent(s) Adjusted Gross Income from IRS Form 
Parent(s) U.S. Income Tax Paid 
Parent(s) Exemptions Claimed 
Father's Income Earned from Work 
Mother's Income Earned from Work 
Parent(s) Amount from Worksheet A 
Parent(s) Amount from Worksheet B 
Parent(s) Amount from Worksheet C 
Parent(s) Net Worth of Current Investments 
Parent(s) Net Worth of Businesses/Investment Farms 
Parent(s) Cash, Savings, and Checking 
 
Step 5. (Q85 - Q86)
Student's Number of Family Members in 2003-2004 1
Student's Number in College in 2003-2004 1
 
Step 6. (Q87 - Q99)
First College GODDARD COLLEGE (003686)
First Housing Plan 
Second College NEW COLLEGE OF CALIFORNIA (010831)
Second Housing Plan 
Third College CALIFORNIA INST OF INTEGRAL STUDIES (012154)
Third Housing Plan 
Fourth College UNIVERSITY OF HAWAII AT MANOA (001610)
Fourth Housing Plan 
Fifth College NAROPA UNIVERSITY (014652)
Fifth Housing Plan 
Sixth College SONOMA STATE UNIVERSITY (001156)
Sixth Housing Plan OFF CAMPUS
 
Student E-mail Address hearthstone@myway.com
 
Preparer's Social Security Number 
Preparer's EIN 
 
Intermediate Worksheet Values
 
Worksheet A Student(44) / Parent(s)(79)
Earned Income Credit $0 /
Additional Child Tax Credit $0 /
Welfare Benefits $0 /
Untaxed Social Security Benefits $5000 /
TOTAL $5000 /
 
Worksheet B Student(45) / Parent(s)(80)
Payments to Tax-Deferred Pensions & Savings $0 /
Deductible IRA/Keogh Payments $0 /
Child Support Received $0 /
Tax Exempt Interest Income $0 /
Foreign Income Exclusion $0 /
Untaxed Portions of IRA Distributions $0 /
Untaxed Portions of Pensions $0 /
Credit for Federal Tax on Special Fuels $0 /
Housing, Food, & Living Allowances $0 /
Veterans' Noneducation Benefits $0 /
Other Untaxed Income or Benefits $0 /
Cash Received (not reported elsewhere) $0 / XXXXX
TOTAL $0 /
 
Worksheet C Student(46) / Parent(s)(81)
Education Credits $0 /
Child Support Paid $0 /
Taxable Work-Study Earnings $0 /
Grant and Scholarship Aid (reported in AGI) $0 /
TOTAL $0 /
 
Question 35 Worksheet
Convicted of possession/sale? NO
All convictions removed? 
Completed drug rehab? 
How many possession convictions? 
Date of possession conviction 
Date of last possession conviction 
How many sale convictions? 
Date of sale conviction 
Drug Conviction Affecting Eligibility? ELIGIBLE FOR AID

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